Kor Daryl J, Brown Michael J, Iscimen Remzi, Brown Daniel R, Whalen Francis X, Roy Tuhin K, Keegan Mark T
Department of Anesthesiology, Division of Critical Care, Mayo Clinic College of Medicine, Rochester, MN, USA.
J Cardiothorac Vasc Anesth. 2008 Apr;22(2):210-6. doi: 10.1053/j.jvca.2007.12.019.
To evaluate how the presence and timing of statin therapy affect perioperative renal outcomes after major vascular surgery.
Retrospective cohort study.
Surgical intensive care unit at a single academic medical center.
Patients undergoing major vascular surgery between July 2004 and October 2005.
The presence and timing of perioperative statin administration and the propensity for receiving such therapy were noted. Renal outcomes, lengths of stay, and mortality were reviewed. One hundred fifty-one procedures were performed. Eighty-nine patients (59%) received statin therapy. There was no evidence for renal protection with perioperative statin therapy (Delta creatinine 0.2 mg/dL v 0.2 mg/dL, p = 0.41; acute renal injury/acute renal failure 8% v 6%, p = 1.00; renal replacement therapy 3% v 3%, p = 1.00; all statin v no statin, respectively). With the possible exception of early reinstitution of statin therapy in chronic statin users, subgroup analyses failed to confirm an association between statin timing and prevention of postoperative renal dysfunction.
In the present investigation, neither the presence nor timing of perioperative statin therapy was associated with improved renal outcomes in patients undergoing a range of major vascular procedures. A possible exception is early postoperative reinitiation of statin therapy in chronic statin users. The discrepant results of available literature preclude a definitive statement on the use of statin therapy as a means of preventing postoperative renal dysfunction. An adequately powered prospective trial is needed before advocating the routine use of statin therapy for perioperative renal protection.
评估他汀类药物治疗的使用情况及时间对大血管手术后围手术期肾脏预后的影响。
回顾性队列研究。
一家学术医疗中心的外科重症监护病房。
2004年7月至2005年10月期间接受大血管手术的患者。
记录围手术期他汀类药物给药的使用情况及时间，以及接受此类治疗的倾向。回顾肾脏预后、住院时间和死亡率。共进行了151例手术。89例患者（59%）接受了他汀类药物治疗。围手术期他汀类药物治疗没有肾脏保护作用的证据（肌酐变化0.2mg/dL对0.2mg/dL，p = 0.41；急性肾损伤/急性肾衰竭8%对6%，p = 1.00；肾脏替代治疗3%对3%，p = 1.00；分别为所有使用他汀类药物组对未使用他汀类药物组）。除了可能在慢性他汀类药物使用者中早期重新开始使用他汀类药物治疗外，亚组分析未能证实他汀类药物使用时间与预防术后肾功能障碍之间存在关联。
在本研究中，围手术期他汀类药物治疗的使用情况及时间与接受一系列大血管手术患者的肾脏预后改善均无关联。一个可能的例外是慢性他汀类药物使用者术后早期重新开始使用他汀类药物治疗。现有文献结果存在差异，无法就使用他汀类药物治疗作为预防术后肾功能障碍的手段做出明确表述。在提倡常规使用他汀类药物治疗进行围手术期肾脏保护之前，需要进行一项有足够样本量的前瞻性试验。
